scholarly journals Undertaking general practice quality improvement to improve cancer screening - a thematic analysis of provider experiences

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Steven A. Trankle ◽  
Christine Metusela ◽  
Jennifer Reath
Keyword(s):  
General Practice ◽  
Quality Improvement ◽  
Cancer Screening ◽  
Thematic Analysis ◽  
Community Education ◽  
Practice Staff ◽  
Health Network ◽  
Primary Health ◽  
Incidence And Mortality ◽  
General Practices

Abstract Background Cancer is a major cause of illness and death, and its incidence and mortality can be reduced through effective screening. In order to improve below target screening rates in one region of Australia, the local Primary Health Network supported local general practices to implement a range of quality improvement initiatives. Methods We used a qualitative approach and interviewed 18 general practice staff and five Primary Health Network staff and contractors to understand their experiences with these quality improvement initiatives. Results In a thematic analysis, we identified four key themes related to program set-up and implementation; patient and community education and promotion; engaging patients and communities in screening; and general practice enhancement. Program roles were clear and understood, and the program received strong oversight and support. Practice staff felt supported and motivated. Information Technology was a challenge for many practices often requiring tailored assistance. Education provided by practices facilitated patient empowerment but practice staff noted difficulties engaging patients in screening. Practices were enhanced though strong leadership and teamwork and practice learning activities. Conclusions The tailored evidence-based quality improvement initiatives were considered effective in supporting general practices to increase their cancer screening. Key facilitators reported by participants included use of Plan-Do-Study-Act cycles, enhanced data entry and audit capacity, effective recall and reminder systems and maintaining staff motivation.

scholarly journals Undertaking General Practice Quality Improvement to Improve Cancer Screening - A Thematic Analysis of Provider Experiences

2021 ◽  
Author(s):  
STEVEN A TRANKLE ◽  
CHRISTINE METUSELA ◽  
JENNIFER REATH
Keyword(s):  
General Practice ◽  
Quality Improvement ◽  
Cancer Screening ◽  
Thematic Analysis ◽  
Community Education ◽  
Practice Staff ◽  
Health Network ◽  
Primary Health ◽  
Incidence And Mortality ◽  
General Practices

Abstract Background: Cancer is a major cause of illness and death, and its incidence and mortality can be reduced through effective screening. In order to improve below target screening rates in one region of Australia, the local Primary Health Network supported local general practices to implement a range of quality improvement initiatives.Methods: We used a qualitative approach and interviewed 16 general practice staff and five Primary Health Network staff and contractors to understand their experiences with these quality improvement initiatives.Results: In a thematic analysis, we identified four key themes related to program set-up and implementation; patient and community education and promotion; engaging patients and communities in screening; and general practice enhancement. Program roles were clear and understood, and the program received strong oversight and support. Practice staff felt supported and motivated. Information Technology was a challenge for many practices often requiring tailored assistance. Education provided by practices facilitated patient empowerment but practice staff noted difficulties engaging patients in screening. Practices were enhanced though strong leadership and teamwork and practice learning activities.Conclusions: The tailored evidence-based quality improvement initiatives were considered effective in supporting general practices to increase their cancer screening. Key facilitators reported by participants included use of Plan-Do-Study-Act cycles, enhanced data entry and audit capacity, effective recall and reminder systems and maintaining staff motivation.

scholarly journals Youth StepCare: A pilot study of an online screening and recommendations service for depression and anxiety among youth patients in general practice.

2019 ◽  
Author(s):  
Belinda Parker ◽  
Melinda Rose Achilles ◽  
Mirjana Subotic-Kerry ◽  
Bridianne O'Dea
Keyword(s):  
Mental Illness ◽  
General Practice ◽  
Anxiety Symptoms ◽  
Self Report ◽  
Depression And Anxiety ◽  
Practice Staff ◽  
Factors Affecting ◽  
Patient Health ◽  
Seeking Help ◽  
General Practices

Abstract Background: General Practitioners (GPs) are ideally placed to identify and manage emerging mental illness in young people, however, many report low levels of confidence in doing so. A web-based universal screening service delivered via a mobile tablet, Youth StepCare, was developed to assist GPs in identifying depression and anxiety symptoms in youth patients. This service also provided evidence-based treatment recommendations and fortnightly monitoring of symptoms. The current study assessed the feasibility and acceptability of delivering the Youth StepCare service in Australian general practices. Methods: A 12-week uncontrolled trial was undertaken between August 2018 and January 2019 in two general practices in NSW, Australia. The service was offered to all youth patients aged 14-17 years who visited a participating GP during the screening period with their parent or guardian. Youth patients reported the presence of depressive and anxiety symptoms using the self-report Patient Health Questionnaire-9 and the Generalised Anxiety Disorder Questionnaire-7. New cases were defined as those who reported symptoms but were not currently seeking help from their GP, nor had sought help in the past. Feasibility and acceptability among GPs and practice staff were assessed using a battery of questionnaires. Results: Five GPs and 6 practice staff took part. A total of 46 youth patients were approached, 28 consented and 19 completed the screener (67.9%). Nine reported symptoms of anxiety or depression, two of which were new cases (22.2%). GPs and practice staff were satisfied with the service, reporting that there was a need for the service, and that they would use it again. Conclusions: The Youth StepCare service appears to be a useful tool for identifying youth with unidentified symptoms of mental illness that can be easily embedded into general practice. Further research would benefit from exploring the factors affecting initial GP uptake and a larger trial is required to determine the efficacy of the service on young people’s symptom reduction.

scholarly journals The Nursing Presence in General Practice: Revealing Dimensions of Day-to-day Experience of Practice Nurses in New Zealand

2021 ◽  
Author(s):  
◽  
Katrina Fyers
Keyword(s):  
Health Care ◽  
General Practice ◽  
Primary Health Care ◽  
New Zealand ◽  
Models Of Care ◽  
Complex Nature ◽  
Practice Nurses ◽  
Nursing Leaders ◽  
Primary Health ◽  
General Practices

<p>This study makes visible and gives value to the day-to-day experience of practice nurses who work in New Zealand general practices. Nursing leaders internationally and locally have highlighted the importance of the Primary Health Care nurse to improving health outcomes, addressing inequalities and implementing new models of care. As one of the largest groups of Primary Health Care nurses, practice nurses have a significant part to play. There is however, no consensus and limited research related to the day-to-day experience of practice nurses. Therefore, the nature, extent, and contribution of nursing in general practice may be overlooked or misunderstood. Furthermore as an autonomous self-regulating profession, nursing has a responsibility to the public to provide understanding of nursing in the present and in the future, particularly when this relates to the care of families and the structure of health systems. Located within the qualitative research paradigm and utilising a narrative inquiry methodology, this study applies a 'supportive voice' to highlight the experience of five practice nurses, and in the process makes visible the dimensions of nursing work in New Zealand general practices. The five constructed narratives particularly draw attention to the complex nature of nursing work that practice nurses engage in daily, the importance of nurse-patient relationships and continuity of care and the significance of autonomous and specialty aspects of nursing practice. Ultimately, the value of the practice nurse in the day-to-day operation of general practice is brought to the fore.</p>

scholarly journals Community engagement in general practice: a qualitative study

2019 ◽  
Vol 11 (2) ◽  
pp. 146 ◽  
Author(s):  
N. Rowe ◽  
R. Keenan ◽  
L. Lack ◽  
N. Malloy ◽  
R. Strasser ◽  
...  
Keyword(s):  
Health Care ◽  
General Practice ◽  
Primary Health Care ◽  
Qualitative Study ◽  
Conceptual Framework ◽  
Community Engagement ◽  
Perceived Benefits ◽  
Primary Health ◽  
General Practices ◽  
Systematic Framework

ABSTRACT BACKGROUNDCommunity engagement is believed to be an important component of quality primary health care. We aimed to capture specific examples of community engagement by general practices, and to understand the barriers that prevent engagement. METHODSWe conducted 20 distinct interviews with 31 key informants from general practice and the wider community. The interviews were semi-structured around key relevant topics and were analysed thematically. RESULTSKey themes identified from the interview transcripts included an understanding of ‘community’, examples of community engagement and the perceived benefits and barriers to community-engaged general practice. We particularly explored aspects of community engagement with Māori. CONCLUSIONSGeneral practices in the study do not think in terms of communities, and they do not have a systematic framework for engagement. Although local champions have generated some great initiatives, most practices seemed to lack a conceptual framework for engagement: who to engage with, how to engage with them, and how to evaluate the results of the engagement.

scholarly journals Learning from the Implementation of a Quality Improvement Intervention in Australian General Practice: A Qualitative Analysis of a CVD Preventive Care Project

2021 ◽  
Author(s):  
Charlotte Hespe ◽  
Edwina Brown ◽  
Lucie Rychetnik
Keyword(s):  
General Practice ◽  
Quality Improvement ◽  
Health System ◽  
Financial Incentives ◽  
Clinical Care ◽  
Quality Improvement Intervention ◽  
Successful Implementation ◽  
Full Potential ◽  
Australian General Practice ◽  
General Practices

Abstract BackgroundQuality-improvement collaborative (QIC) initiatives aim to reduce gaps in clinical care provided in the healthcare system. This study provides a qualitative evaluation of a QIC project (QPulse) in Australian general practice focused on improving cardiovascular disease (CVD) assessment and management. MethodsThis qualitative-methods study explored implementing a QIC project by a Primary Health Network (PHN) in 34 general practices. Qualitative analyses examined in-depth interviews with participants and stakeholders focusing on barriers and enablers to implementation in our health system. They were analysed thematically using the Complex Systems Improvement framework (CSI), focusing on strategy, culture, structure, workforce, and technology.ResultsDespite strategic engagement with QPulse objectives across the health system, implementation barriers associated with this program were considerable for both PHN and the general practices. Adoption of the QIC process was reliant on engaged leadership, practice culture, systems for clear communication, tailored education and regular clinical audit and review. Practice ownership, culture and governance, rather than practice size and location, were related to successful implementation. Financial incentives for both the PHN and general practice were identified as prerequisites for systematised quality improvement (QI) projects in the future, along with individualised support and education provided to each practice. Technology was both an enabler and a barrier, and the PHN was seen as key to assisting the successful adoption of the available tools. ConclusionsImplementation of QI programs remains a potential tool for achieving better health outcomes in General Practice. However, enablers such as individualised education and support provided via a meso-level organisation, financial incentives, and IT tools and support are crucial if the full potential of QI programs are to be realised in the Australian healthcare setting. Trial registrationACTRN12615000108516, UTN U1111-1163-7995.

scholarly journals Youth StepCare: A pilot study of an online screening and recommendations service for depression and anxiety among youth patients in general practice.

2019 ◽  
Author(s):  
Belinda Parker ◽  
Melinda Rose Achilles ◽  
Mirjana Subotic-Kerry ◽  
Bridianne O'Dea
Keyword(s):  
Mental Illness ◽  
General Practice ◽  
Anxiety Symptoms ◽  
Self Report ◽  
Depression And Anxiety ◽  
Practice Staff ◽  
Factors Affecting ◽  
Patient Health ◽  
Seeking Help ◽  
General Practices

Abstract Background: General Practitioners (GPs) are ideally placed to identify and manage emerging mental illness in young people, however, many report low levels of confidence in doing so. A web-based universal screening service delivered via a mobile tablet, Youth StepCare, was developed to assist GPs in identifying depression and anxiety symptoms in youth patients. This service also provided evidence-based treatment recommendations and fortnightly monitoring of symptoms. The current study assessed the feasibility and acceptability of delivering the Youth StepCare service in Australian general practices. Methods: A 12-week uncontrolled trial was undertaken between August 2018 and January 2019 in two general practices in NSW, Australia. The service was offered to all youth patients aged 14-17 years who visited a participating GP during the screening period with their parent or guardian. Youth patients reported the presence of depressive and anxiety symptoms using the self-report Patient Health Questionnaire-9 and the Generalised Anxiety Disorder Questionnaire-7. New cases were defined as those who reported symptoms but were not currently seeking help from their GP, nor had sought help in the past. Feasibility and acceptability among GPs and practice staff were assessed using a battery of questionnaires. Results: Five GPs and 6 practice staff took part. A total of 46 youth patients were approached, 28 consented, and 19 completed the screener (67.9%). Nine reported symptoms of anxiety or depression, two of which were new cases (22.2%). GPs and practice staff were satisfied with the service, reporting that there was a need for the service, and that they would use it again. Conclusions: The Youth StepCare service appears to be a useful tool for identifying youth with unidentified symptoms of mental illness that can be easily embedded into general practice. Further research would benefit from exploring the factors affecting initial GP uptake and a larger trial is required to determine the efficacy of the service on young people’s symptom reduction.

scholarly journals Spirometry and FeNO testing for asthma in children in UK primary care: a prospective observational cohort study of feasibility and acceptability

2020 ◽  
Vol 70 (700) ◽  
pp. e809-e816
Author(s):  
David Lo ◽  
Caroline Beardsmore ◽  
Damian Roland ◽  
Matthew Richardson ◽  
Yaling Yang ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Practice Staff ◽  
Number Of Children ◽  
East Midlands ◽  
Observational Cohort ◽  
General Practices ◽  
Diagnostic Work ◽  
Training And Support ◽  
Work Up

BackgroundThe National Institute for Health and Care Excellence recommends the use of spirometry and measuring the fraction of exhaled nitric oxide (FeNO) as part of the diagnostic work-up for children with suspected asthma, and spirometry for asthma monitoring, across all care settings. However, the feasibility and acceptability of these tests within primary care are not known.AimTo investigate the feasibility, acceptability, training, and capacity requirements of performing spirometry and FeNO testing in children managed for asthma in UK primary care.Design and settingProspective observational study involving 10 general practices in the East Midlands, UK, and 612 children between 2016 and 2017.MethodTraining and support to perform spirometry and FeNO in children aged 5 to 16 years were provided to participating practices. Children on the practice’s asthma registers, and those with suspected asthma, were invited for a routine asthma review. Time for general practice staff to achieve competencies in performing and/or interpreting both tests, time to perform the tests, number of children able to perform the tests, and feedback on acceptability were recorded.ResultsA total of 27 general practice staff were trained in a mean time of 10.3 (standard deviation 2.7) hours. Usable spirometry and FeNO results were obtained in 575 (94%) and 472 (77%) children respectively. Spirometry is achievable in the majority of children aged ≥5 years, and FeNO in children aged ≥7 years. All of the staff and 97% of families surveyed provided positive feedback for the tests.ConclusionAfter training, general practice staff obtained quality spirometry and FeNO data from most children tested. Testing was acceptable to staff and families. The majority of general practice staff reported that spirometry helped them to manage children’s asthma better.

scholarly journals General practice's early response to the COVID-19 pandemic

2020 ◽  
Vol 44 (5) ◽  
pp. 733
Author(s):  
Michael Wright ◽  
Roald Versteeg ◽  
Jane Hall
Keyword(s):  
General Practice ◽  
Early Response ◽  
Models Of Care ◽  
Protective Equipment ◽  
Practice Staff ◽  
Australian Health ◽  
Pandemic Planning ◽  
Community Transmission ◽  
General Practices

The COVID-19 pandemic has resulted in multiple changes in the delivery of general practice services. In response to the threat of the pandemic and in order to keep their businesses safe and viable, general practices have rapidly moved to new models of care, embraced Medicare-funded telehealth and responded to uncertain availability of personal protective equipment with innovation. These changes have shown the adaptability of general practice, helped keep patients and practice staff safe, and undoubtedly reduced community transmission and mortality. The pandemic, and the response to it, has emphasised the potential dangers of existing fragmentation within the Australian health system, and is affecting the viability of general practice. These impacts on primary care highlight the need for improved integration of health services, should inform future pandemic planning, and guide the development of Australia’s long-term national health plan.

Accreditation in Primary Health: RACGP Standards for General Practice

2003 ◽  
Vol 31 (2) ◽  
pp. 1-6 ◽  
Author(s):  
Halina Hili
Keyword(s):  
General Practice ◽  
Continuous Quality Improvement ◽  
Health Expenditure ◽  
Accreditation Process ◽  
Accreditation System ◽  
Continuous Quality ◽  
Primary Health ◽  
Profound Influence ◽  
General Practices ◽  
The Impact

General Practitioners play a crucial role as “gate-keepers” to the health system. In this context, they have a profound influence on both health outcomes and health expenditure. Since the introduction in 1999 of a formal, peer-driven external accreditation process, over 4,590 Australian general practices have achieved full accreditation. The process of re-ccreditation has commenced, subsequent to a review of the original standards, and with an ongoing focus on continuous quality improvement. This article describes a typical accreditation survey visit, and explains the accreditation criteria and how they are reviewed by the surveyors. There is discussion also of the impact of this new accreditation system on general practice.

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